Objective: Missing premeal boluses negatively impacts glycemic outcomes in automated insulin delivery (AID) users. This prospective interventional study compared postprandial glycemia after missed bolus across three AID systems in children with type 1 diabetes (CwD). Methods: CwD using MiniMed 780G (780G), Tandem Control-IQ (CIQ), or Ypsomed CamAPS (CamAPS) consumed 30 g and 50 g of carbohydrates (CH) in the form of standardized enteral nutrition, purposely omitting a premeal bolus. The mean area under the curve (AUC) of glucose concentration change and continuous glucose monitoring metrics were analyzed over 4 h postprandially and compared between the systems. Results: Forty-three CwD completed the study (mean age = 13 years, mean HbA1c = 47 mmol/mol 6.5%). The lowest mean AUC was reached by 780G, followed by CIQ and CamAPS (137 vs. 144 vs. 156 mmol/L·sec·10 3 , P < 0.01). Similar trends were seen after 50 g of CH. CamAPS users spent more time in level 2 hyperglycemia (26% for 30 g, 42% for 50 g) compared to CIQ (9.9% and 26%) and 780G (5.0% and 21%; P < 0.001). Conclusions: AID systems differ in their capacity to compensate for missed premeal boluses. 780G and CIQ outperformed CamAPS in limiting postprandial hyperglycemia, suggesting they may be preferable for CwD prone to bolus omission.
Šantová et al. (Thu,) studied this question.